What Is the Connection between Atrial Fibrillation and Exercise?

Paroxysmal atrial fibrillation is caused by intermittent rapid and irregular atrial rhythms caused by multiple reentrant wavelets, which is ectopic tachycardia with a pacing point in the atrium. Irregular impulses occur in the atrium at 350 to 600 beats / min during the attack, causing uncoordinated atrial fibrillation. The atrioventricular conduction system can only conduct conduction in part of the atria. Ventricular beats are rapid and irregular during paroxysmal atrial fibrillation, between 120 and 180 beats / min. Paroxysmal atrial fibrillation is one of the most common arrhythmias in adults, far more common than atrial flutter, and the ratio of the two is 10 to 20: 1. Paroxysmal relapses can be persistent.

Paroxysmal atrial fibrillation

Paroxysmal atrial fibrillation is caused by multiple reentrant wavelets that are intermittently fast and irregular and the atrial rhythm is the pacemaker in the atrium.

The vast majority occur

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Symptoms may include palpitations, chest tightness, and panic.

Features of ECG: P wave disappears and is replaced by continuous, regular atrial flutter wave or continuous, irregular atrial fibrillation wave. It is clearer on leads II, III, aVF or V3R, V1, and V2. The P wave of atrial fibrillation disappears and is replaced by a flutter wave (f wave) of varying size, shape, and irregularity. Atrial impulse in the atrioventricular junction

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In addition to the cause and inducement treatment, consideration should be given to the control of ventricular rate and arrhythmia during the onset of arrhythmia, as well as measures to prevent recurrence.

Paroxysmal atrial fibrillation controls ventricular rate

Patients with atrial fibrillation with an unfavorable ventricular rate at the onset may be left untreated. If the ventricular rate is high during the attack, the -blocker, verapamil or digitalis preparation should be selected according to the rapid heart rate and the degree of affecting the circulatory function. With organic heart disease, especially when combined with cardiac insufficiency, digital medicine is preferred for intravenous administration to control the ventricular rate below 100 beats / min and then to oral maintenance. Adjust the dosage so that the ventricular rate is 60 at rest. 70 beats / min, not more than 90 beats / min during light activities. Atrial flutter is mostly converted to atrial fibrillation, and sinus rhythm may be restored during continued use or inactivation of digitalis. After a few patients with atrial fibrillation, the heart rhythm can also return to sinus after the above treatment. Atrial fibrillation with preexcitation syndrome, especially

Ventricular rate control beta blockers

It is a QRS comprehensive wave widening deformity that is not suitable for treatment with the above-mentioned drugs. When sick sinus syndrome is associated with short-onset atrial fibrillation, the above medications should be performed on the basis of electrical pacing.

Paroxysmal atrial fibrillation

(1) The indications of cardioversion are converted to sinus rhythm in time, which can restore the role of atrial assisted ventricular filling, thereby increasing the stroke volume and improving cardiac function; secondly, it can prevent the formation of thrombus and embolism in the atrium. Cardioversion can be considered in the following cases: persistent atrial fibrillation after removal of the basic cause, such as hyperthyroidism and mitral valve disease surgery; patients with digitalis preparations who have poor efficacy due to aggravated heart failure due to the occurrence of atrial fibrillation; A history of arterial embolism; Atrial fibrillation lasts less than one year, the heart enlargement is not significant and there is no serious heart disease damage; Atrial fibrillation with hypertrophic cardiomyopathy.

Cardioversion should not be performed in the following cases: those with atrial fibrillation lasting more than one year and whose cause has not been removed; those with atrial fibrillation with severe mitral regurgitation and large left atrium; those with slow ventricular rate (non-drug influence); Paroxysmal atrial fibrillation with diseased sinus syndrome; Those who have difficulty maintaining sinus rhythm after cardioversion.

(2) Method of cardioversion

Synchronous DC cardioversion room requires low electrical power, and the success rate of electrotransformation is also high, and the risk is less than that of quinidine transversion. Those with conditions should choose it first.

For cardioversion, quinidine or amiodarone is commonly used. When taking quinidine cardioversion, first try 0.1g and observe for 2 hours. If there is no allergic reaction, take 0.2g every 2 hours for a total of 5 times during the day. Auscultate the heart and measure blood pressure before each administration and record whether there is a toxic reaction. When it was found that the heart rhythm had been restored or a toxic reaction occurred (such as blood pressure drop, QRS complex time limit increased by more than 25%, ventricular premature beats, or QT interval significantly prolonged), immediately discontinued the drug or changed the maintenance amount. If the heart rhythm is not reverted and there is no toxic reaction, the single dose can be increased to 0.3g and taken for another day. Higher doses are prone to shock and severe ventricular arrhythmias and should be used with caution. The maintenance amount of quinidine is 0.2g every 6 hours, and it can be changed to 0.2g 3 times / d. Quinidine in combination with propranolol or metoprolol can enhance the efficacy and prevent recurrence. When using amiodarone for cardioversion, 0.2g every 6 to 8h, and the drug should be discontinued when it is not taken for 7 to 10 days after oral administration. After conversion to sinus rhythm, it was changed to a maintenance amount (0.2g, 1-2 times / d) for a long time. Observe heart rate, heart rate, blood pressure, QRS time limit, and QT interval closely during medication. Those who have obvious bradycardia and / or significantly longer QT interval should stop the drug immediately. During long-term maintenance, serious side effects such as thyroid function and pulmonary fibrous pneumonia need to be closely observed. In the case of cardioversion with propafenone, 150-200 mg is usually taken orally every 6 hours. After successful cardioversion, the dosage is gradually reduced for a long time. If the medication fails to be changed for a week, the medication is discontinued. This medicine is effective for cardioversion of acute atrial fibrillation, but it has a poor effect on cardioversion of chronic atrial fibrillation.

Paroxysmal atrial fibrillation prevents recurrence

Atrial flutter and atrial fibrillation recur. After treatment with drugs or electrotransformation, long-term oral quinidine, propafenone, amiodarone and other drugs are required to maintain it. The recurrence rate was higher in those who did not remove the cause.